AB0158 PREDICT OF PROGNOSIS AT ONE YEAR AFTER THE ADMINISTRATION WITH b/tsDMARD FOR PATIENT WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS
Authors: I. Yoshii, N. Sawada, T. Chijiwa
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with difficult-to-treat rheumatoid arthritis (D2T RA) are the most serious problem in recent systemic RA treatment protocols [1]. Objectives Prognosis after biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) is beneficial when predicted in patients with D2T RA. Predictors of post b/tsDMARDs in D2T RA patients were investigated using retrospective cohort data. Methods RA patients more than 1 year after the start of newly administered b/tsDMARDs were recruited. The patients were divided into two groups according to the EULAR definition of D2T RA [2]. Patients who met the criteria were classified into the D2T RA group and others into the non-D2T RA group. The incidence of the clinical features described in the criteria of D2T RA and the rheumatoid disease comorbidity index (RDCI) [3] were compared between the two groups at the time of drug initiation (baseline). The primary endpoint was “Success or Failure” 1 year after baseline. Success was defined as b/tsDMARD persisted in remission as the 28 joint disease activity score with erythrocyte sedimentation rate (DAS28) ≤ 2.6, or as b/tsDMARD was discontinued upon achieving clinical remission. The Failure was defined as other decisions such as discontinuation due to failure, adverse events, or characteristic patient problems. In the discontinued cases, the monitoring value at the last observation was carried forward to 1 year. Cox regression analysis was used to assess each variant as a potential risk factor for Failure. Receiver operating characteristic analysis (ROC) was tested on variants with significantly higher risk ratios, and Kaplan-Meier survival analysis was also tested for cut-off indices. Results 71 cases of the D2T RA and 259 cases of the non-D2T RA group were analyzed. As shown in Table 1, the clinical characteristics of the D2T RA group were significantly worse than those of the non-D2T RA group. Higher DAS28 had a significantly higher risk ratio for the Failure from month 3 in the D2T RA group, whereas from baseline in the non-D2T RA group (Figure 1-A). Other factors in the D2T RA group at and after baseline listed in the Table 1 had no significant risk ratios. PS-VAS and EQ5D score had significant higher risk ratios in the non-D2T RA group using univariate models, however, only DAS28 had significant higher risk ratio using multivariate model. The cut-off index (COI) and the area under the curve (AUC) using ROC for each observational period in the two groups were shown in Figure 1-B. Results of Kaplan-Meier survival analyses were shown in Figure 1-C. Hazard ratios of DAS28 &gt; COI exceeded 2.5 even from months 3 with high sensitivity (p &lt; 0.001) in the D2T RA group. Conclusion These results indicated that higher DAS 28 suggested a failure prognosis at 12 months after initiation in D2T RA and non-D2T RA patients. Even in patients with D2T RA, strict disease activity control is most important for prognostic management, with 1-year prognosis predictable in the first 3 months. However, this study is a short-term prognostic predictor, and accumulation of short-term predictions is a long-term predictor. References [1]Roodenrijs NMT, et al. Rheumatology (Oxford) 2021;60:3778-3788. doi:10.1093/rheumatology/keaa860 [2]Nagy G, et al. Ann Rheum Dis 2021;80:31-35. [3]England BR, et al. Arthritis Care Res 2015;67:865-872. doi: 10.1002/acr22456. Disclosure of Interests None declared